Rebirth 1977 Great Era

Chapter 1387 Childhood Purpura, Thirty Grams of Rhinoceros Horn (Bonus Chapter for Monthly Tickets)

Dingzhen Pill was invented by Wang Kentang, a traditional Chinese medicine doctor in the Ming Dynasty.

It is recorded in his book "Zheng Zhi Zhun Sheng" as a special prescription for treating tremor.

This prescription consists of Gastrodia elata, Gentiana macrophylla, Scorpion, Asarum heterotropoides, Rehmannia glutinosa (processed), Rehmannia glutinosa (raw), Angelica sinensis, Ligusticum chuanxiong, Paeonia lactiflora, Saposhnikovia divaricata, Schizonepeta tenuifolia, Atractylodes macrocephala, Astragalus membranaceus, and Clematis chinensis. It has the effects of invigorating qi and nourishing blood, dispelling wind and stabilizing tremor. It is mainly used to treat tremor in the elderly caused by deficiency of both qi and blood and invasion of wind.

Based on Mr. Song's condition, Fang Yan proposed removing Asarum, Saposhnikovia divaricata, Schizonepeta tenuifolia, and Atractylodes macrocephala from the formula, and adding earthworm, centipede, and other insect-based medicines. At the same time, the dosage of Astragalus membranaceus was increased to replenish qi and blood. This combination of insect-based medicines not only promotes blood circulation and removes blood stasis, but also has the effect of calming wind and unblocking the meridians. Just as Ye Tianshi said, "If it goes on for a long time, evil and righteousness will be mixed together, and herbs will not be effective. Insect medicines should be used to clear the channels and expel evil."

Moreover, according to Zhu Lao's experience records, in this case, insect medicine must be taken by roasting and grinding it into a fine powder; if it is decocted, the effect will not be as good.

He paused, then noted the dosage on the prescription:

"Angelica sinensis 10g, Ligusticum chuanxiong 10g, Rehmannia glutinosa (raw and prepared) 15g each, Paeonia lactiflora (red and white) 10g each, Astragalus membranaceus (prepared) 50g, Gastrodia elata 10g, Gentiana macrophylla 10g, Clematis chinensis 15g, Pheretima aspergillum 10g, Buthus martensii 5g (roasted, ground, and swallowed), two centipedes (roasted, ground, and swallowed)"

When Fang Yan was writing the prescription, Mr. Song's son also came to look at the prescription Fang Yan had written. When Fang Yan wrote down the last two items, he frowned.

Only after he finished writing in the dialect did he ask:

"Are these scorpions and centipedes the venomous insects in the literal sense?"

Fang Yan nodded and said:
"Yes."

Upon hearing this, Mr. Song's son asked nervously:

"Dr. Fang, these are both poisonous insects! A scorpion's tail can sting, and a centipede can bite. Will they cause problems if they eat them? My father is old and his health is already weak. What if he gets poisoned..."

Mr. Song was equally nervous. When he heard that he was going to be given worms, he started babbling as if he wanted to say something.

He explained to them in dialect:
"Don't worry, the scorpions and centipedes used in traditional Chinese medicine are all processed whole. The venom glands of the scorpions have been removed, and the heads and feet of the centipedes have been removed. After being dried over a low flame, the toxicity has been greatly reduced. It's like when we eat crabs, we remove the gills, and when we eat shrimp, we remove the shrimp vein. These are all methods of removing toxicity while retaining efficacy."

"Traditional Chinese medicine has been using insect-based medicines to treat diseases for thousands of years. The Shennong's Classic of Materia Medica records that scorpions can 'extinguish wind and stop spasms' and centipedes can 'unblock the meridians and relieve pain.' As long as the dosage is controlled and the treatment is done properly, they are not only safe but also more effective than ordinary herbal medicines. Mr. Song's tremor has lasted for so long that ordinary medicines cannot penetrate the deep meridians. He needs these two 'masters of unblocking the meridians' to clear the blocked meridians so that his hand tremors and stiffness can be relieved."

“Some of the patients I treated before used scorpions and centipedes, in much larger doses than Mr. Song’s, and they didn’t experience any discomfort. Moreover, the pharmacists are all seasoned professionals with decades of experience in handling insect-based medicines, so there will absolutely be no problems.”

"Besides, this medicine isn't meant to be chewed directly by the patient; it's crushed into powder and swallowed whole, so there won't be any special sensation."

Mr. Song listened from the side and slowly said, "I...I trust Dr. Fang. Eat...eat it, as long as it will make you better."

Mr. Song's son breathed a sigh of relief when he saw that his father had agreed: "Okay, then we'll do as Dr. Fang says. Please remind the pharmacy to make sure it's clean."

Fang Yan knew that this was a hurdle that money could overcome in one's own mind.

He nodded in agreement:

"Of course, we have standards for that."

After hearing Fang Yan finish speaking, Mr. Song nodded. Although the insect medicine was beyond his understanding, the most important thing now was to get back to normal. There was no other way. Even if he couldn't get over it in his mind, he could only grit his teeth and swallow it.

Just treat it as a trip to sample local cuisine...

Then, Fang Yan told them to go and complete the admission procedures, and at the same time, he asked the medical staff to go to the pharmacy to prepare the medicine.

After Fang Yan finished completing the medical record, he called in the next patient.

The last patient was a young boy, about ten years old.

When he came in, his nose was stuffed with a wad of blood-soaked paper, and his face was swollen, as if he had been beaten. However, Fang Yan recognized him at a glance; this was probably a moon face caused by taking hormones.

His father and Fang Yan had met at the last reception banquet. This man's surname was Gu, and he ran a catering business in several countries.

The child asked in dialect:

"Where does the child feel unwell?"

The child looked at his parents, then pointed to his hands and legs and said:
"My feet and hands are bruised."

Fang Yan put down her pen, stood up, and went to the child.

Upon examining the child's sleeves and trouser legs, we discovered purpura, and quite a few of them.

Purpura is a purplish-red or dark red spot or patch on the skin or mucous membrane that does not fade when pressed. It is essentially a bleeding point formed by the rupture of subcutaneous capillaries.

Fang Yan looked at his father and asked:
"When did it appear?"

"It started last July. The nanny noticed it when she was dressing him. At first, there were tiny bruises the size of rice grains on his calves, densely distributed. They were bright red at first, then turned purplish-red. They didn't hurt or itch. We took him to the hospital, and the doctor gave him an injection of penicillin. He was fine after three days."

"For the next two months, there were no abnormalities. Then in October, it reappeared. It started on my calves, then spread to my ankles and thighs. We took me to get injections, but it didn't get better. It spread all over my body. Finally, the doctor insisted that we be hospitalized for IV fluids, which we agreed to. But the condition didn't improve after the IV fluids. Instead, the small, grain-like rashes became larger and larger, and it got worse and worse. So we quickly transferred to the best hospital in the area. After evaluation, the doctors there started treating me with hormones. That's when my condition started to improve. After several months of treatment, the bleeding spots on my body disappeared, but the rashes on my arms kept recurring."

"Moreover, now the child's face is not only swollen, but his back is also swollen, and his nose bleeds frequently. Look, he was still bleeding from his nose this morning."

"Later, we heard about your story and decided to come back and try it out to see if traditional Chinese medicine could cure this disease."

Fang Yan nodded and asked them:

What hormones do you use for treatment? Are you still using them now?

“I’m using it. Look, this is it. I need to take 300mg every day to control it.” At this moment, the child’s mother took out a box, handed it to Fang Yan and said.

Judging from the dialect, it's prednisone tablets.

Fang Yan took the prednisone box, pinching the pill packaging between his fingertips, his brows furrowing slightly—prednisone is a commonly used glucocorticoid, and a daily dose of 300mg is not low for a ten-year-old child. Long-term use can cause typical side effects such as moon face and back edema, and can also lead to fragile nasal mucosa and easy nosebleeds.

He returned the medicine box to the child's mother, squatted down, gently lifted the little boy's sleeve, and carefully examined the recurring purpura on his arm. The purpura was dark red in color and distributed from the wrist to the elbow. The purpura varied in size and did not fade when pressed. Unlike the "rice-grain-sized petechiae on the calves" described earlier, the current purpura was more of a "severe stasis" type.

"Besides nosebleeds and purpura, how is the child's eating and toileting? Does he complain of stomach aches or joint pain?" Fang Yan observed while asking about key symptoms. Allergic purpura often affects the digestive tract and joints, and these details are important for diagnosis. The child's father quickly replied, "He eats well and isn't picky, but his stools are sometimes dry; he hasn't complained of stomach aches, but occasionally he says his knees hurt and he's afraid to run hard; he sleeps soundly at night, but he's prone to nosebleeds in the morning, sometimes even in the middle of the night, and I have to pat his forehead with cold water to stop them."

Fang Yan nodded and then asked the little boy to stick out his tongue.

The little boy was obedient and stuck out his tongue to show Fang Yan.

The tongue coating was thin and white, and the tip of the tongue was reddish, which is a typical tongue appearance of "blood heat and stagnation".

He then gently held the child's wrist to feel the pulse.

After feeling both hands, I confirmed that the pulse was thin and rapid.

The fine lines indicate deficiency, and the rapid lines indicate heat, confirming the pathogenesis of "yin deficiency with blood heat and blood stasis."

"Dr. Fang, how is it?" Mr. Gu, the child's father, asked Fang Yan.

“In traditional Chinese medicine, this condition is called ‘purple spots’,” Fang Yan stood up and explained to the child’s parents.

He paused and continued:

"The first attack occurred last July and was cured with penicillin, indicating that it was 'wind-heat damaging the collaterals' and the pathogenic factor was relatively superficial at that time. Later, it repeatedly worsened, coupled with long-term use of hormones. In traditional Chinese medicine, hormones are considered 'pure yang substances'. Pure yang will deplete the child's yin and blood, which will then lead to 'yin deficiency generating internal heat'. The internal heat forces the blood to flow erratically, which will cause repeated purpura and nosebleeds. Moon face and back swelling are also manifestations of 'water and dampness stagnation' caused by hormones."

The child's parents only half understood what they were hearing, but the child seemed quite interested. He remained calm throughout, as if he wasn't the one who was sick.

Fang Yan looked at the child, smiled, picked up a pen to record in the medical record, and continued, "Current pathogenesis: Yin deficiency and blood heat, blood stasis, and water retention. Treatment strategy: nourish Yin and clear heat, cool blood and stop bleeding, unblock the meridians and remove dampness, while also taking into account the conditioning after the reduction of hormone dosage to avoid recurrence of the condition."

When the child's mother heard about "reducing hormone dosage," her eyes lit up but she also became somewhat worried.

"Dr. Fang, can we gradually stop using hormones? We're worried that long-term use will be bad for the child, but we're also afraid that the symptoms will relapse if we stop..."

"You can reduce it gradually, but you can't rush it," Fang Yan said.

In general, it is recommended to stop taking the medication directly, but this is not a general case. Stopping the medication directly after taking 300mg could very likely cause problems.

Fang Yan continued:

"We need to first use medication to clear the 'internal heat' and 'stagnation' in the child's body, so that the body can adapt to the state after the hormone dosage is reduced, and then gradually adjust the dosage. Now it is 300mg per day. After the Chinese medicine takes effect, we will try to reduce it to 250mg, observe and then continue to reduce it, step by step."

The child's father quickly pressed for an answer:

"How long does it take for the Chinese medicine to take effect? ​​We don't want our child to have a swollen face and nosebleeds all the time."

"It depends on his constitution. His condition has been going on for a while, so the dosage is different from that of adults. We have to try it out," Fang Yan explained.

Mr. Gu nodded; he understood the dialect.

Fang Yan paused, then continued:

"The main focus should be on cooling the blood and detoxifying. If, after two days, there are no new purpura on the arms and the frequency of nosebleeds decreases, it means the treatment is effective, and then the prescription can be adjusted."

Mr. Gu nodded, agreeing to Fang Yan's arrangement. He was mainly at a loss for what to do, so he would do whatever Fang Yan said.

He was worried that his son might not be able to withstand taking that hormone medication again.

At this point, Fang Yan had already started writing prescriptions.

60g of raw Rehmannia glutinosa, 15g of Rubia cordifolia root, 30g of Rheum palmatum, 30g of Ulmus pumila, 18g of Paeonia lactiflora, 15g of Artemisia capillaris, 9g of raw Glycyrrhiza uralensis, 6g of charred Platycodon grandiflorus, 9g of processed Atractylodes macrocephala, 12g of roasted Astragalus membranaceus, 6g of Cimicifuga foetida, and 30g of Rhinoceros horn.

To be honest, many of the ingredients in this prescription are things that people in this area don't usually use. Just 30 grams of rhinoceros horn alone would be enough for an average family to drink a whole pot of medicine.

Moreover, this thing isn't something you can just buy whenever you want. The only exception was when Mr. Lee, the president of the Malaysian Chamber of Commerce, donated some because his wife had a nosebleed due to menstrual irregularities. Otherwise, Fang Yan would still have to find someone to source the goods.

In addition, the herb *Vaccaria segetalis* is also used frequently in pediatrics. It is suitable for children because their spleen and stomach are delicate and cannot tolerate bitter and cold medicines. This medicine can target the "blood heat and toxic evil" of purpura without damaging the spleen and stomach.

Finally, relatively little charcoal is used; this is made by processing bellflower root through "charring".

Traditional Chinese medicine believes that "charcoal can stop bleeding" and that Platycodon grandiflorus can "guide the medicine upward". For children's "nasal mucosal bleeding", charcoal Platycodon grandiflorus can guide other blood-cooling medicines in the prescription to act on the upper jiao, accurately stop bleeding, and avoid the "dispersion of the effect" of other hemostatic medicines.

After writing it down, Fang Yan called out to them:
"Alright, go and complete the admission procedures. The medicine should arrive in about half an hour."

Upon hearing this, Mr. Gu quickly expressed his gratitude in dialect, and then left with his wife and children, led by the nurse.

Fang Yan finished writing the medical record and then went out with the prescription.

He went to the next room first and saw that his master, Lu Donghua, was still treating patients. He simply greeted him and said that he had finished his clinic.

Master Lu Donghua told him to just go ahead and do as he was told.

Fang Yan nodded and then went to make the usual phone call to the dean to report.

After reporting to them, Fang Yan went to the traditional Chinese medicine pharmacy and gave them the last prescription.

Fang Yan then went to the guesthouse to find Shen Zhanyao and Ma Xinghua. It would be a good time to take them there to see Zhang Fu.

We also need to check on Wang Zhenlin; he's still in the hospital ward, and we don't know if he's caused any trouble.

Fang Yan actually really wanted this old guy to do something, but he was afraid that he would just stay out of it.

P.S.: I still owe you 43,000 words after finishing this chapter.

The extra chapter of 4,000 words has been completed.

(End of this chapter)